Utilization Management: Payer Models

Course overview

Managed care began as a solution to growing healthcare costs and poor quality. Various healthcare delivery and payment models emerged under managed care, but none were maximally efficient or effective in reducing healthcare costs. This course details the evolution of managed care and its payer models. Military payers and other models of healthcare payment are also discussed. The goal of this course is to equip nurses and case managers with knowledge of utilization management as it applies to various payer types and models in the acute care setting.